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03/2012 journal articles

ANTIOXIDANT EFFECTS OF A NUTRITIONAL SUPPLEMENT CONTAINING POLYPHENOLS AND MICRONUTRIENTS IN POSTMENOPAUSAL WOMEN: A RANDOMIZED CONTROLLED STUDY

N.N. Kang, A.V. Rao, K. De Asis, L.Chan, L.G. Rao

J Aging Res Clin Practice 2012;1(3):183-187

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Background: Oxidative stress is an important factor in the development of osteoporosis. Antioxidants counteract the damaging effect of oxidative stress, which may reduce the risk of osteoporosis. Nutritional supplements, such as greens+TM and greens+ bone builderTM that contain water-soluble polyphenols and other micronutrients beneficial for bone health, are of recent interest as complementary strategies in the management of osteoporosis. Objective: Clinically evaluate the antioxidant properties of greens+ bone builderTM in postmenopausal women. Design: Forty-seven postmenopausal women, 50-60 years old were recruited for a ten-week clinical study. During week 1, participants recorded their baseline food intake. During week 2, the participants refrained from consuming polyphenol-rich foods, beverages and supplements. The participants were then randomized to either Treatment group consuming 1 scoop (equivalent to ¼ cup) daily of greens+ bone builderTM (N=23) or Placebo (N=24) group for a period of 8 weeks. Blood samples were collected at 0, 4 and 8 weeks of supplementation, processed and assayed for serum total antioxidant capacity (TAC), lipid peroxidation and protein oxidation as markers of oxidative stress. Results: Statistical analysis showed that after 4 and 8 weeks, the Treatment group significantly increased their serum total antioxidant capacity and decreased in lipid peroxidation and protein oxidation while the Placebo group showed no significant changes. These were also significantly different from those of the Placebo group. Conclusions: Results suggest that a daily supplementation with greens+ bone builderTM may be important in reducing oxidative damage, thus reducing the risk of osteoporosis in postmenopausal women.

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THE ASSOCIATION BETWEEN RISK FACTORS AND OBESITY OF THE INDONESIAN JAVANESE

F. Hutasuhut

J Aging Res Clin Practice 2012;1(3):188-192

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Background: Obesity mainly in elderly people has a role in increasing degenerative diseases such as hypertension, diabetes, coronary heart disease, and atheroscleross. Objective: The study aimed to assess the prevalence of obesity and its risk factors in The Javanese elderly people. Design: A cross sectional study towards nutritional status. Setting: Yogyakarta, Surabaya, and Semarang Cities represented urban areas, while for the rural areas represented by Magetan, Gunung Kidul, and Wonogiri Districts. Participants: The indicators of obesity towards 812 elderly Javanese (consisting of 295 men and 517 women) in December 2007. Measurement: Anthropometry measured using Omron Body Fat Analyzer HBF 352, microtoise, and SECA. Results: More than one fourth of respondents were obese (32.1%) and the others were normal weight (57.7%), and underweight (10.2%). High level of body fat percentage was twice higher (80.7%) than the high level of visceral fat (39.5%). The composition of respondents in the rural areas (55.5%) were almost similar to the urban areas (45.5%). Majority of respondents were female (63.7%) with low education (59.2%). Low to middle level of energy expenditure were mostly spent when they were aged 25 and 55 years of age. Most of respondents had lack of energy, protein, and fat intakes when they aged 25 and 55 years of aged. Rural and urban areas, gender, and employment status when the elderly aged 25 had a significant relationship with BMI (p <0.01). Significant relationships were also found between BMI with visceral fat and percent body fat (p <0.01). Female elderly people has the probability twice higher to be obese than male. Conclusion: Obesity need to be aware by the elderly people mainly female including risk factors because of their role in the increased incidence of obese elderly although underweight was still found in among the same population group..

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BENEFICIAL EFFECTS OF DAILY DIETARY OMEGA-3 POLYUNSATURATED FATTY ACID SUPPLEMENTATION ON AGE-RELATED COGNITIVE DECLINE IN ELDERLY JAPANESE WITH VERY MILD DEMENTIA: A 2-YEAR RANDOMIZED, DOUBLE-BLIND,

M. Hashimoto, K. Yamashita, S. Kato, T. Tamai, Y. Tanabe, M. Mitarai, I. Matsumoto, M. Ohno

J Aging Res Clin Practice 2012;1(3):193-201

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Background: Studies of the effects of dietary omega-3 polyunsaturated fatty acid intake on cognitive functions in elderly Japanese are lacking. In this 2-year randomized, double-blind, placebo-controlled trial, we primarily aimed to examine the effects of daily dietary docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) supplementation on cognitive functions in healthy elderly Japanese. Methods: Independently living community dwellers aged 57 years or over (n = 111, 72.4 ± 7.7 years) were randomized to active and placebo groups. The active group consumed fish sausages containing 1720 mg DHA and 407 mg EPA daily for 24 months; the placebo group consumed fish sausages containing olive oil daily for the first 12 months and fish sausages containing DHA and EPA daily for the next 12 months. Cognitive functions were assessed by using the Revised Hasegawa's Dementia Scale (HDS-R), Mini-Mental State Examination (MMSE), and Frontal Assessment Battery (FAB) and blood biochemistry was analyzed at the baseline and 6, 12, 18, and 24 months thereafter. Results: The mean baseline HDS-R, MMSE, and FAB scores were not significantly different between the placebo and the active groups. On average, the plasma and erythrocyte plasma membrane DHA and EPA levels significantly increased in the active group at 6 and 12 months, but were not significantly different between the groups at 24 months. Further, at 6 and 12 months, the mean total HDS-R, MMSE, and FAB scores were not significantly different between the groups, but the mean changes in FAB-subitem “Conflicting instructions” scores from the baseline to month 6 and MMSE-subitem “Language: copying” scores from the baseline to month 12 were significantly greater in the active group. Depending on the responses to the MMSE, the subjects were also grouped as responders and nonresponders. The mean changes in the total MMSE scores and MMSE-subitem “Attention and Calculation” scores from the baseline to month 12 were significantly greater in the responders of the active group. Conclusion: Long-term daily dietary DHA and EPA supplementation seems to have beneficial effects against age-related cognitive decline in otherwise healthy elderly Japanese with very mild dementia.

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SERUM 25-HYDROXYVITAMIN D LEVEL AND RISK FOR INCIDENT STROKE IN CHINESE COMMUNITY-DWELLING OLDER MEN

R. Chan, D. Chan, J. Leung, J. Woo, C. Ohlsson, D. Mellström, P. Leung, T. Kwok

J Aging Res Clin Practice 2012;1(3):202-208

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Objective: This study examined the association of serum vitamin D level and stroke incidence in older Chinese men. Design: Prospective cohort study. Setting: Hong Kong, China. Participants: 939 community-dwelling Chinese men aged 65 and older. Measurements: Baseline serum 25-hydroxyvitamin D (25OHD) level was measured using a competitive radioimmunoassay kit. Data on stroke incidence between 2001 and 2008 were retrieved from territory-wide hospital database. Cox regression analyses were performed with adjustments for age, body mass index, serum parathyroid hormone level, education, season of blood sampling, self-reported history of stroke and diabetes, hypertension status, and lifestyle factors. Results: Seventy nine (8.4%) men had incident stroke. In either crude or adjusted models, serum 25OHD level was not associated with stroke incidence. Results remained unchanged when serum 25OHD level was divided into quartiles or dichotomized into low (<50 nmol/L) and adequate (>=50 nmol/L) levels for analyses. Subjects with increasing age [adjusted HR (95% CI), 1.08 (1.03-1.13)], higher serum PTH level [2.58 (1.49-4.45)] and self-reported history of stroke [5.40 (3.01-9.71)] were associated with higher stroke incidence (p<0.001). Conclusions: The findings show no association between serum 25OHD level and risk of stroke in older Chinese men. The lack of association may possibly be due to the relatively high serum 25OHD level of the study ample. The implication of the positive association of serum PTH level with stroke incidence was limited by the lack of renal function measurements in this study.

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DIETARY VITAMIN D INTAKE IS ASSOCIATED WITH SKELETAL MUSCLE MASS IN COMMUNITY-DWELLING OLDER JAPANESE WOMEN

M. Yamada, K. Terai, S. Nishiguchi, K. Yoshimura, Y. Kajiwara, T. Sonoda, T. Aoyama

J Aging Res Clin Practice 2012;1(3):209-212

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Background & purpose: Recently, several studies have suggested that low serum 25-hydroxyvitamin D levels are associated with sarcopenia (age-related loss of skeletal muscle mass). However, the relationship between dietary vitamin D intake and skeletal muscle mass in older adults remains unclear. The purpose of this cross-sectional study was therefore to determine whether dietary vitamin D intake is associated with muscle mass in community-dwelling older Japanese women. Methods: Ninety-one older Japanese women (mean age, 73.0 ± 5.5 years) participated in this cross-sectional study. We measured the skeletal muscle mass index(SMI) of the participants using bioelectrical impedance, the intake of several dietary nutritional factors using a food-frequency questionnaire, and physical activity. Results: The SMI correlated with level of vitamin D intake(r=0.208, p=0.037) and body mass index (r=0.330, p=0.001). Regression analysis revealed that vitamin D (β=0.308; 95% confidence interval, 0.022–0.303) was a significant and independent determinant of the SMI (p<0.001). Conclusion: Dietary vitamin D intake is associated with the SMI in older, community-dwelling Japanese women.

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NUTRITIONAL INTERVENTION DURING HOSPITALIZATION IN MALNOURISHED PATIENTS

F. Bon, P. Manckoundia, P. Pfitzenmeyer, V. VanWymelbeke

J Aging Res Clin Practice 2012;1(3):213--218

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Background: Malnutrition affects up to 60% of older people at hospital. Objective: To diagnose the nutritional status of patients admitted to a geriatric care unit and to assess the effects of specific nutritional followup to improve the nutritional status of hospitalised patients compared with standard care in the same care unit. Design and intervention: Patients were 75 years and older were able to eat normally and the malnourished status was evaluated by either a MNA short-form score < 11 points or albumin (alb) level < 35g/L or transthyretin (TTR) < 0.2 g/L. The study comprised two groups: the interventional group (IG) received specific nutritional intervention for a maximum of 20 days and the control group (CG) received no specific encouragement other than that usually provided in the care unit when malnutrition was detected. At admission, day 0, the MNA, anthropometric data, autonomy levels (ADL, IADL), cognitive and depressive status, blood parameters (Alb, TTR and C-reactive protein, CRP) and 3-day food intake were measured. At day 10, ADL and 3-day food intake were measured. Finally at day 20, blood parameters and 3-day food intake were measured. Subjects: The nutritional status of all patients admitted to the geriatric care unit was systematically assessed and fifty hospitalised elderly people (87.2 ± 5.9 years old) were recruited in the geriatric unit to participate in the study with specific nutritional follow-up (IG n = 22; CG n = 28). Statistical analysis: All data are presented as mean ± standard deviation (SD) for all patients for the interventional and control groups. Student t-test was used to determine the effect of nutritional intervention on blood samples and food intake. Results: 478 people were hospitalised in the acute geriatric care unit, age was 85.6 ± 6.4 years and the length of stay 20.1 ± 10.9 days. Among these, 61.5% were malnourished and 73 accepted to participate in the study. Complete results were obtained for analysis for 50 patients. On admission, the average blood parameters, in particular alb and TTR were low and CRP was high, which showed an inflammatory status. After 10d of intervention, changes in levels of alb, TTR and CRP were highly significant in the IG (p=0.005 for alb; p=0.0003 for TTR; p=0.0004 for CRP). In the CG, changes in TTR and CRP were also significant (p=0.001 for TTR and p=0.003 for CRP). An increase in TTR values occurred in only 67.8% of patients in the CG against 86.4% in the IG. An increase in calorie intake was noted for 72.7% of the IG against only 46.4% of the CG. Conclusion: Intervention given to patients during the first 10 days of the hospital stay can re-initiate food intake, and thus improve blood parameters. However the nutritional intervention does not lead to better outcomes compared to usual care.

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SCREENING FOR SARCOPENIA IN A SMALL COHORT OF ELDERLY CARE HOME RESIDENTS USING HANDGRIP STRENGTH DYNAMOMETRY; AND BIOELECTRICAL IMPEDANCE ASSESSMENT OF SKELETAL MUSCLE MASS AND FAT FREE MASS

A. Slee

J Aging Res Clin Practice 2012;1(3):219-224

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Objective: The loss of skeletal muscle strength and mass termed sarcopenia is linked to disability, frailty, nutritional risk and poor outcomes in the elderly. This study aimed to perform screening for sarcopenia in a group of elderly care home residents using handgrip strength (HGS) dynamometry and bioelectrical impedance assessment (BIA). Design: An observational study performed over a 2 month period with BIA screening performed at week 0 and HGS at 0, 4 and 8. Setting: A residential care home in Lincolnshire, United Kingdom. Participants: 14 elderly Caucasian participants were recruited (8 females and 6 males), mean age 85.6 ±6.2 (77-96). Measurements: Anthropometric measurements (height, weight, mid-upper arm (MUAC) and calf circumferences (CC)), calculation of body mass index (BMI), HGS, and BIA (Bodystat ®1500 MDD) were performed. Skeletal muscle mass index (SMI), kg/m2 was calculated using an equation by Janssen et al, 2000 and fat free mass index (FFMI), kg/m2 using both the Bodystat manufacturers equation and from Kyle et al, 2000. Cut-off points and criteria from the European Working Group on Sarcopenia in Older People (EWGSOP) for HGS and SMI were utilised to determine the presence of sarcopenia and values for FFMI compared and correlated with variables including SMI, BMI, MUAC, CC and age of participants. Results: HGS indicated that functional strength was low compared to reference values and cut-off points. SMI values indicated that all males (6/6) had some degree of sarcopenia and 3/8 females moderate sarcopenia (1 other borderline). FFMI analysis indicated good correlation with SMI and BMI (r = > 0.82; P < 0.0001) and moderately with MUAC and CC (r = 0.59-0.78; P < 0.05-0.0001), regardless of BIA equation used. Distinct regions of potential nutritional risk were identified on FFMI/SMI and /BMI graph-plots, whereby low FFMI and SMI coexisted in normal and even overweight BMI ranges. Conclusion: These results indicate that the utilisation of a combination of tools and methods may provide useful and practical information in the assessment of sarcopenia.

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PERSONALITY AND BODY MASS INDEX IN ELDERLY PEOPLE LIVING IN THE COMMUNITY IN JAPAN

H. Iwasa, I. Kai, Y. Masui, Y. Gondo, C.Kawaai, H. Inagaki

J Aging Res Clin Practice 2012;1(3):225-229

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Objective: To examine the relationship between personality and body mass index (BMI) in a sample of elderly Japanese people living in the community. Design: We used a cross-sectional study design. Setting: We conducted the study in a community setting. Participants: We studied 950 individuals (401 men and 549 women) aged 65–77 years. Measurements: The participants self-reported their height and weight and we used these to calculate their BMIs. We divided the participants into three groups: underweight (BMI < 18.5), normal (BMI 18.5–24.9) and overweight (BMI ≥ 25.0). We administered the Eysenck Personality Inventory (EPI) to assess the personality traits of neuroticism and extraversion. After stratifying the data by sex, we performed multivariate logistic regressions adjusted for age, presence of chronic diseases, and instrumental activities of daily living for each personality trait to test the correlations between personality and BMI (underweight and overweight). Results: The proportions of underweight, normal and overweight individuals were identical between sexes, being 11.7%, 71.3% and 16.9% in men and 12.6%, 67.8% and 19.7% in women, respectively. Logistic regression showed that neuroticism was associated with being underweight both in men (1-standard-deviation [SD] increment; odds ratio [OR] = 1.59, p < 0.01) and women (OR = 1.37, p < 0.01), and that extraversion was associated with being overweight in men (OR = 1.32, p < 0.05), and negatively associated with being underweight in women (OR = 0.70, p < 0.01). Conclusion: Our results suggest that neurotic older men and women are more likely to be underweight, that extraverted elderly men are more likely to be overweight, and that extraverted elderly women are less likely to be underweight.

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EFFECT OF NON-ALCOHOLIC BEER ON OLDER ADULTS´ HOMOCYSTEINE LEVELS

N.A. Cunha, M.B. Noronha, S.F. Abrunhosa, A.N. Rocha, T.F. Amaral

J Aging Res Clin Practice 2012;1(3):230-234

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Objective: To evaluate the effectiveness of non-alcoholic beer (NAB) and non alcoholic beer with a high content of folic acid (NAB-FA) in reducing hyperhomocysteinemia amongst older adults. Design: Quasi-experimental study. Setting: Care homes for older adults. Participants: Forty older adults aged 72 to 96 years (mean=83), with high serum homocysteine (Hcy) levels, >11µmol/L in women and >12μmol/L in men. Intervention: Those who reported liking NAB were randomly assigned to drinking 500 ml/day of NAB (n=8) or NAB-FA (43.7μg of folic acid/100 mL) (n=9). Those who reported not liking NAB were allocated to the control group (n=23), 500ml/day of water. Measurements: Serum levels of Hcy, folic acid and cobalamin evaluated at baseline and after the intervention. Results: A higher reduction in Hcy levels was observer after beer (NAB and NAB-FA) than after water ingestion (3.2µmol/L, interquartile range (IQR)=3.2µmol/L, p<0.001 compared with 0.9µmol/L, IQR=1.5µmol/L, p<0.001). Compared to the water ingestion, this reduction in Hcy levels was higher after NAB-FA intake (3.55µmol/L, IQR=2.1µmol/L, p=0.011) than after NAB (2.45µmol/L, IQR=6.3µmol/L; p=0.132). Conclusion: Three week intake of non-alcoholic beer significantly decreased Hcy levels in older adults with advanced age. When folic acid was integrated into NAB, a considerably lower dose of folic acid was necessary in order to reduce Hcy plasma levels than previously described for that purpose.

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PRESENTATION OF SCURVY IN SAUDI ARABIA; IT IS STILL SEEN!

S. Al Faraj

J Aging Res Clin Practice 2012;1(3):235-236

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Four cases of scurvy due to dietary deficiency of ascorbic acid, seen in a relatively affluent community. Various reasons were contributing to this deficiency.

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EFFECT OF A HOLISTIC MEAL AND AMBIANCE CONCEPT ON MAIN MEAL ENJOYMENT AND FOOD INTAKE OF DUTCH NURSING HOME RESIDENTS: A PILOT STUDY

S. Kremer, J. Derks, M. Nijenhuis-De Vries, E.P.J. Boer, M. Gorselink

J Aging Res Clin Practice 2012;1(3):237-244

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Objectives: To explore whether or not the implementation of a holistic meal and ambiance concept has the potential to increase the meal enjoyment and/or influence food intake of the elderly in nursing homes who already eat in a social setting. Design: In a longitudinal design two groups of subjects (comparison group & experimental group) participated in a 12-week study encompassing an 8-week intervention. In the first four weeks, all residents consumed their normal main meals in the usual setting. In the following eight weeks, the intervention was applied to the experimental group (n=28). The comparison group (n=40) received no intervention. Both groups were interviewed twice (in week 4 and 12). Setting: Real-life setting (Dutch nursing homes). Subjects: Sixty-eight long-term nursing home residents with primarily somatic disorders. Results: The total amount of energy intake for the main meal showed no significant difference between the experimental and comparison group. However, in the experimental group a significant higher intake of vegetables, starch and applesauce and a lower intake of sauce was observed as well as an increased duration of the meal. The meal enjoyment was improved for the items time spent at the table and satisfaction with the amount of food. Conclusions: Within 8 weeks of intervention, duration of the meal, meal enjoyment and to a lesser extent food intake of nursing home residents can already be influenced. These influences were already achieved in a relative short time, which is promising for the long term.

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NASOGASTRIC TUBE INSERTION: A SIMPLE AND PRAGMATIC APPROACH TO PRACTICE IMPROVEMENT

D. Aw, A. Blundell, C. Kotsapas, A. Hill, J. Snape

J Aging Res Clin Practice 2012;1(3):245-247

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Fine bore nasogastric tube insertion for enteral feeding is a common procedure performed in hospitals by health care professionals. It is not without risks. The current recommendation for checking nasogastric tube placement is via the use of pH indicator strips, with chest radiography a second line alternative. The National Patient Safety Agency have highlighted cases of death and serious harm from misplaced nasogastric tubes, and it has been recently deemed as a ‘never event’ by the Department of Health. We audited the practice of nasogastric tube insertion in the elderly care medicine wards in a district general hospital over a period of 16 months, and found that, following the recommendations from our initial audit, we could demonstrate that, with improved junior doctor education, in addition to the appointment of a Nutritional Specialist Nurse, that pH testing to check tube positioning increased from 0% to 61% for initial insertions and from 4% to 69% for subsequent insertions. The total number of chest radiographs per patient was also reduced from 2.76 to 0.83.

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EFFECTS OF A NUTRITION COUSELING ON FUNCTIONAL CONSTIPATION IN THE BRAZILIAN ELDERLIES: A PILOT STUDY

A.M. Cervato-Mancuso, M.M. Hernandes de Abreu de Oliveira Salgueiro

J Aging Res Clin Practice 2012;1(3):248-251

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Objective: The aim of this study is to assess the effects of the nutritional counseling for elderly with functional constipation. Methods: The intervention study with two groups (intervention, n=21; and control, n=19) was conducted at school-hospital service. The intervention group received individual counseling by training nutritionist. The data was: age; Body Mass Index; social class; complaints about the intestinal habit; food intake; physical. The Fisher and the Mann-Whitney tests and the MacNemar and the Wilcoxon Sign tests were used. Results: It was observed that members of the intervention group reduced the number of complaints and the number of laxatives. An increase on the intake of fibers and liquids without altering the intake of a specific food group was also verified. Conclusion: It should also be highlighted that besides being individualized, the educational intervention based on the counseling theoretical model can decrease the symptomatology of functional intestinal constipation in elderly patients.

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BODY MASS INDEX ESTIMATION ON GASTROSTOMY PATIENTS USING THE MID UPPER ARM CIRCUMFERENCE

M. Pereira, C. Santos, J. Fonseca

J Aging Res Clin Practice 2012;1(3):252-255

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Introduction/aim: Body Mass Index (BMI) portrays nutritional status through the equation Weight/Height2. In Endoscopic Gastrostomy (PEG) patients, BMI is easy to determine when gastrostomy is performed. As the disease progresses, patient becomes bedridden, BMI becomes problematic to evaluate. In PEG-patients, we compared estimated BMI values obtained through Mid Upper Arm Circumference (MUAC) and regression equations described by Powell-Tuck/Hennessy (BMIPTH) with values from Weight/Height2 (BMIQI), in order to assess whether those equations could estimate the BMI in an equivalent way. Patients/Methods: In an adult PEG-patients retrospective study, we computed BMIQI and BMIPTH at date of gastrostomy. BMI (BMIQI and BMIPTH) was sorted into 3 categories: underweight (<18,5 Kg/m2), normal (18,5-24,9 Kg/m2), overweight/obesity (> 25 Kg/m2). BMIQI and BMIPTH were compared, first globally, and then according to gender and age (≥65/<65). Results: From 157 patients (124 males), aged 20-89 years, most were in normal BMI range. BMIQI and BMIPTH placed most patients in the same categories. There was no statistically significant differences between BMIQI (mean: 20,55±4,34) and BMIPTH (mean: 20,29±4,13). Similar results were obtained in gender and age analysis. Conclusion: Values obtained by MUAC and Powell-Tuck/Hennessy’s regression equations were equivalent to Weight/Height2. These equations can be an alternative for PEG bedridden patients.

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VITAMIN D, AGING AND CHRONIC DISEASES

P. Tuohimaa

J Aging Res Clin Practice 2012;1(3):256-268

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Aging is a complex event and several separate molecular mechanisms lead to the same endpoint, normal or premature senescence. The interrelationships between different signaling systems involved in aging remain speculative. Aging is characterized by gradual loss of stress tolerance due to an accumulation of DNA and protein damages. According to a dominating hypothesis the damages are caused by the oxidative stress. The repair mechanisms, anti-oxidative enzymes, IGF signaling, sirtuins and NFκB play an important role in the premature aging. Vitamin D is a prohormone and currently there are at least three cholecalciferol hormones (CHs): 1α-calcitriol (1α,25(OH)2D3), calcidiol (25OHD3) and 24-calcitriol (24,25(OH)2D3). A combination of 1α-calcitriol and calcidiol seems to act synergistically in the target cells regulating several functions including aging. The physiological circulating levels of calcidiol or 1α-calcitriol alone are not sufficient for biological responses. There is a reciprocal relationship between these metabolites (a negative feedback control), which seems to regulate the endocrine balance of CHs. CHs have been demonstrated to be key factors in the regulation of most of these mediators and therefore they play a central role in aging. It seems that an optimal calcidiol serum concentration might delay aging. On the contrary, calcidiol imbalance may lead to a premature aging and earlier appearance of chronic diseases (osteoporosis, cancer, atherosclerosis, neurodegenerative disorders etc) as a sign of aging. Epidemiological studies on the role of hormonal forms of vitamin D3 in chronic diseases are inconsistent. There are several reasons to this inconsistency and one of the reasons might be a non-linear dependency on calcidiol serum concentrations. A U- or J-shaped risk curve is typical to hormones such as steroids, thyroid hormones, retinoids as well as cholecalciferol hormones. The phenomen is known as hormesis. CHs seem to have harmful effects on health and accelerate aging both at low and high serum concentrations. This suggests that there is an optimal serum concentration of calcidiol, which delays aging. The elderly people are in a high risk of vitamin D insufficiency with aging (cholecalciferolpause), because they are not exposed to sun and their skin has a low capacity to produce vitamin D3. Selected studies based on several health outcomes suggest that the optimum is between 40-80 nmol/ L (16-32 ng/ml). This level is reached, if the daily vitamin D dose in the elderly is 10-20 μg. However, more studies are needed on several common degenerative diseases, before the final vitamin D recommendations to elderly can be made.

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